scotto wrote:no graft, just keep it dressed as per a burn IMO.it may seem that A+E staff and GP's more often these days seem either afraid to make such calls or ignorant about injury management. Too often i see young kids with greenstick fractures for example that went from A+E to ortho specialist just to be told "plaster for 4 weeks" and $190 thanks.....

It's largely about risk management and avoidance of litigation!

If the general staff make the call and there's a complication (never say never), then the court will likely side with the "suffering" patient and criticise the lack of "expert" referral. Further, if the general staff do make the call, then a portion of the patients will complain about a lack of "proper" treatment. Even the spread of posts in this thread shows it.

Manage the lawyers/courts and the doctors will be more willing to reduce the load on medical resources.

Children and obstetrics are the major litigation bombs that no doctor want to accidentally trigger. Greenstick is all good, as long as it doesn't involve the growth plate or some other obscure complication. Given our medicare cover and litigious system, referral to an orthopod is just logical, unfortunately.

Ken Ho wrote:The king though, is Hypafix, also known as Fixomuls or Mefix. It sticks like shOwtime to a blanket, can get wet and dry again, and allows new skin to form under it. Just put a few layers on in small pieces to avoid creasing, and leave it for a week. You will be amazed at how it heals under that...If you carry one piece of gear for first-aid on a bike, let it be a piece of Hypafix.

So where do you get it ? When I asked at local chemists, the best I got was blank stares; some made me feel like an alienwho'd come to take their first born away

I dunno. I still have an old roll left over form my medical practice. We used to buy it from a medical supply company.

Op-site won't allow epithelialization and cornification of new skin urn it like Hypafix will.

I had a similar injury about a week and a half ago (got hit by another cyclist, of all things!). As it was on the way home from work I had all my followup treatment at the on-site medical centre (large heavy-industrial company with permanent on-site nurses, and doctor on dayshift). Being work nurses, they were able to spend a bit more time treating me and the wounds seem to be healing quite well.

I had my dressing changed every day, this involved...1) cleaning the wound with sterile saline-soaked gauze.2) Inspecting for any signs of infection3) Coating with Solugel to keep it moist while the lower layers of skin grew back, Some nurses used a sterile tounge depresser to spread it around, it looked a bit like icing a cake... Other nurses would simply use the solugel tube to apply directly (with the number of wounds, and the thickness they applied it they would use an entire tube each day so the tube was sterile initially and then disposed of)4) Putting a piece of special gauze over the solugel (some special sterile wound dressing that was vaseline impregnated)5) Putting a sticky sterile cover dressing (like a large band-aid, but with a paper backing, not plastic)6) Putting elastic "stocking bandages" over my knee and elbow as my movement would cause the sticky dressing to un-stick otherwise.

As the inner part of each wound went from white to pink (indicating that the skin had grown back) they let them dry out (I still had a sticky dressing over some to stop clothes from rubbing on the new skin). They seem to be healing reasonably well after this (yesterday I stopped the solugel treatment completely).

Note that my original treatment at the hospital (I was taken there by ambulance as I wasn't able to stand up after the incident - I had other injuries including sprains and a possible fracture) the doctor applied a similar dressing and said to see my GP to get it re-dressed on Monday (the accident was a Friday). With what I now know, it would have been best to start daily re-dressings immediately.

Since the nurses weren't hugely busy, I had a bit of a talk to them about it... Apparently if you let the skin dry out and scab over too soon, then it is possible an infection can get underneath the scab and ulcerate or burrow into the flesh (sounded quite awful to me) and the best thing to do is to keep it moist and let it heal underneath before allowing the surface to heal.

It seems to have worked well... It's the best healing wound I've ever had and they weren't small.

well i didn't go back to the hospital. it seems to be healing. i've still got a gauze and bandage over it, it's still gooey and hasn't scabbed over yet. but the hole has mostly filled in so that's good.

i didn't go as far as maestro but i've kept it clean and changed the dressing every few days.

ok 3 weeks down and there's still a 10c hole in my elbow! i think it's slowly healing up - all of the other parts of the wound have healed, it's just that little piece (as the doc said) that was ground right down. there's fatty tissue there but it seems to be filling in and isn't bleeding (much) anymore.

After a total write off the motorbike crash at about 130Kmh, a stone / rock embedded in the ground tore a hole in my elbow bone. I packed the hole 2 x daily with a small level teaspoon full of salt wetted with metho.

I'd wipe that wound with vetinary grade 10% provoiodine solution. Use an eye dropper bottle and a cotton swab.... best put on the fresh wound.

Disinfects, seals and drys the wound. Best to only use it about 2 x for the first 2 days, from about 3 days onwards it starts to remove the good skin - unless you dilute it like 25:1

Remember using 10% provoiodine solution makes a simple cut finger feel like you just slammed it in the car door.

Did this after crashing out in a crit, back tire blew when cornering at about 40km/h, the leg took all the damage not another mark on me. Lucky for the gloves otherise my hand would have been torn to pieces. Wrist is still sore though.

Thoroughly cleaned in the shower then dryed. Non-stick absorbent pads covered with a regular bandage to keep them on during the weeping stage. This was four days and was changed once.Second skin type dressings for the next 5 days - all fixed.

So in 9 days my leg had grown new skin.

I used to go the dry it out method, never again.

Can appreciate using the above method where there is constant movement, ie elbow joint might not work.